Provider Demographics
NPI:1306484431
Name:AQUINO, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8879 W FLAMINGO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8732
Mailing Address - Country:US
Mailing Address - Phone:702-701-9951
Mailing Address - Fax:
Practice Address - Street 1:5820 MEIKLE LN APT 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-7606
Practice Address - Country:US
Practice Address - Phone:702-497-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant